article · African Journal of Emergency Medicine
Septic shock carries a disproportionately high mortality rate across sub-Saharan Africa, where emerging evidence indicates that aggressive fluid resuscitation may increase mortality, making earlier use of vasopressors potentially advantageous. This study examined the perceptions, availability, and usage patterns of vasopressors across nineteen Tanzanian hospitals at national, zonal, regional, and district levels. Healthcare providers frequently encounter septic shock, with over three quarters treating at least one such patient each week. However, critical shortages persist: three quarters of district hospital staff and almost half of regional hospital staff report having access to vasopressors less than half the time. While most respondents recognise vasopressors as safe and beneficial, the primary obstacles to their administration are physical absence of the drugs and provider discomfort or insufficient knowledge regarding their use. Enhancing drug availability alongside targeted clinician education is therefore required to support clinical sepsis management.
Managing septic shock effectively is critical to lowering high mortality rates in sub-Saharan Africa. Shifting clinical practices toward early vasopressor administration cannot succeed without understanding current local realities. Identifying systemic drug shortages and gaps in clinical training helps healthcare administrators and policy makers direct resources and training programmes to where emergency care needs them most.
The findings highlight an immediate need for reliable pharmaceutical supply chain solutions and targeted clinical training programmes for Tanzanian emergency care providers. Pharmaceutical distributors, medical educators, and healthcare logistics operators could address the identified deficits in vasopressor delivery and provider training. The abstract reflects descriptive baseline operational research, indicating that interventions to resolve supply and educational shortfalls remain at an early planning stage.
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Background: Sepsis carries a disproportionately high mortality in Sub-Saharan Africa. Current international guidelines for management of septic shock advocate for initial fluid resuscitation followed by vasopressors if there is ongoing concern for hypoperfusion. Emerging data suggest patients in sub-Saharan Africa who receives large fluid boluses may have increased mortality and thus earlier initiation of vasopressors may have clinical benefit. Little data exists on the perceptions, availability and use of vasopressors in Tanzania, which may impact the feasibility of this strategy. We aimed to describe the perception, availability and use of vasopressor in Tanzanian emergency care settings, including its barriers. Methods: We conducted a cross-sectional web-based survey among clinicians and nurses from 19 different hospitals throughout Tanzania (national, zonal, regional and district hospitals). Collected data was kept by the principal investigator on a password encrypted computer whereby descriptive statistics were used to summarize the results. Results: Sixty-five healthcare providers completed the survey of whom the majority 53 (81.5 %), work in the emergency medicine department and 50 (76.9 %) reported treating at least one patient with septic shock per week. However, three quarters of respondents from district hospitals and nearly half of those from regional hospitals had access to vasopressors in <50 % of the time. The most common reported barriers to vasopressor use were lack of availability (50.8 %), and lack of comfort or knowledge (43.1 %). Overall, most respondents perceived that vasopressor use is generally safe and helpful for treating septic shock. Conclusions: Nearly all Tanzanian healthcare providers in emergency care settings reported that they had limited access to vasopressors to treat septic shock, as it was not consistently available. In addition to unavailability, lack of knowledge on vasopressor use was also reported as barrier. Our findings suggest that ensuring availability of vasopressors and education in the use thereof would improve sepsis care in Tanzanian hospitals.
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DOI: 10.1016/j.afjem.2025.05.003
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